A personal reflection of working in the NPICU throughout Covid-19
Rachel Grech, Senior staff Nurse & Infection Control Link Nurse – Mater Dei Hospital – Malta
As a Senior Staff Nurse and Infection Control Link Nurse working in the NPICU, the Covid-19 Pandemic brought about various challenges. My first thoughts were how this virus was going to affect our vulnerable patients and how we could best protect them, therefore I set about reading up on as much available literature as I could find and communicated online with nurses from other countries with regards to neonates and Paediatrics. The general consensus was that neonates were rarely affected by covid-19 so this served to allay some fears, however I was still extremely anxious. Our staff canteen and lecture rooms were transformed into wards and all available spaces and corridors now housed hospital beds and mattresses, creating an unnerving atmosphere. Infection control took on unprecedented importance and I found myself to be the reference point for the nurses & midwives in all things Covid, using all available communication means to address queries.
My colleagues with previous ITU experience were prepared for the eventuality of having to float to adult ITU. I held mixed emotions, as on one hand I was quite fearful of being in such a situation but on the other hand I felt quite guilty for not being able to help out fellow nurses in other critical units. Another nagging fear was of bringing something home after my shifts other than my uniform. Several of my colleagues found alternative accommodation and we all had a plan B in mind just in case we needed to be quarantined. Initially we had several nurses in quarantine due to recent travel and others who remained quarantined throughout due to being classed as ‘high risk’, so we all had to adapt and work extra shifts accordingly. I was concerned that in the eventuality of an outbreak there might not be enough staff to care for our patients, since our unit is the only one on the island and our relieving pool is extremely sparse.
Initially I was present for meetings with the infection Control and Neonatal teams to discuss various admission strategies, which involved creating pathways from the delivery suite, theatres, A & E and other Paediatric wards. I also helped with the creation/updating of various protocols with regards to parental presence on the unit, the handling of expressed breast milk, and the disinfection & disposal of contaminated items. It was extremely confusing as pathways kept changing making it next to impossible to keep track of the correct ones.
I was part of a coalition group to carry out certain modifications within the unit. Isolation rooms were stripped down to a bare minimum, item cupboards removed, panelled doors exchanged for glass doors to ensure visibility, appropriate signage was affixed, a communication system was installed and mirrors were fitted to aid with the correct donning of PPE. Centrally located cupboards were installed for all the necessary PPE and various quick access trolleys for difficult airway management were set up. We also assembled packs of collated items to take down to the various ‘Covid theatres’ for caesarian deliveries and a variety of procedure packs. I had to prepare for the eventuality of admitting older paediatric patients which involved procuring unfamiliar equipment and drugs. I even made a trip to the home improvement store to purchase transparent plastic sheeting to prevent aerosolization of viral particles during intubation.
I helped provide simulation training for proning techniques in paediatric ventilated patients and was also tasked with training all the department staff to safely don and doff the necessary PPE. This was not without its difficulties, as simultaneously the nursing & midwifery union was arguing that the PPE we had access to was not adequate, creating a lot of anxiety and mistrust amongst colleagues. This was further compounded by tight restrictions on FFP3 masks. Unfortunately we also had an initial shortage of alcohol based hand rub and wipes with these items being kept under lock and key in the manager’s office; needless to say hand hygiene compliance dropped and I was very worried about the ensuing consequences.
Now that our islands have succeeded in ‘flattening the curve’, I am finally getting used to the new normality of working with a mask and visor throughout my 12-hour shifts. I fear that our patients and parents continue to suffer inadvertently due to the tight restrictions on parent visiting and handling and am currently advocating for this policy to be re-evaluated.